In ICD-10-PCS, coders will need to select the root operation based on the objective of the procedure (not what the physician calls it). If the physician’s objective is to strip out by force all of a...
Do EHRs enable fraud and abuse by encouraging upcoding? What other factors could have led to higher levels of E/M coding over the past decade? Who or what organizations are responsible for ensuring compliance?
When coding guidelines are murky and open for interpretation, coders can sometimes feel as though they're pinned between a rock and a hard place. Discussing the gray areas of coding during a coding roundtable not only helps relieve this tension, but it also helps to establish policies that ensure consistency and continuity.
Charging for inpatient ancillary procedures and supplies has always been confusing. "CMS provides very little guidance ... Its theory is that it's up to the provider to figure it out," says Kimberly Anderwood Hoy, JC, CPC, director of Medicare and compliance at HCPro, Inc., in Danvers, Mass.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
Do EHRs enable fraud and abuse by encouraging upcoding? What other factors could have led to higher levels of E/M coding over the past decade? Who or what organizations are responsible for ensuring compliance?
Upon quick glance, codes for insertion, removal, and revision of pacemakers look quite different in ICD-10-PCS. The good news is that much of the logic that coders use to assign these codes in ICD-9-CM won't change. The silver lining? The procedure itself doesn't change, nor does anatomy.
Coders will see plenty of changes when they start using ICD-10-CM codes. Many codes require more specific information, such as laterality, stage, or encounter.
In this month’s issue, we review the proposed payment rates for molecular pathology testing, discuss CMS’ proposed changes to the definition of inpatient status and how it could affect observation, and provide tips for ICD-10 training. Our experts answer questions about injections and infusions, edits for flushing a line, and coding for irradiated blood products.
Hospital value-based purchasing (HVBP). It's the latest buzz phrase in the healthcare industry, and it's something in which all insurers are interested.
Curious to know what changes the four cooperating parties made to the ICD-10-CM codes for 2014? You can now find out by downloading the 2014 ICD-10-CM codes from the Centers for Disease Control and...
ICD-10 implementation is less than 16 months away, but a recent survey by TrustHCS and AHIMA reveals that 25% of responding healthcare organizations have not yet established an ICD-10 steering committee.
Q: My question pertains to CPT® vasectomy code 55250. This code includes "unilateral or bilateral (separate procedure) including postoperative semen examination(s).” The CPT manual states that a reference laboratory that performs the semen analysis may bill separately for this service. May we bill CPT code 89321 ( semen analysis; sperm presence and motility of sperm, if performed .) in addition to 55250 when the laboratory performs the semen analysis and the surgeon only performs the vasectomy?
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. James S. Kennedy, MD, CCS, CDIP, and Kimberly Anderwood Hoy, JD, CPC, discuss CMS’ proposed changes and how they could affect outpatient observation services.
Outpatient providers are beginning to see more and more medical necessity audits, especially in the ED and for evaluation and management (E/M) levels. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer, and Joanne M. Becker, RHIT, CCS, CCSP, CPC, CPC-I, AHIMA approved ICD-10-CM/PCS trainer, review the guidelines for ED E/M services and highlight common audit risk areas.
Even experienced coders struggle to determine when to append modifiers -58, -78 and -79 because they are very similar in definition, but very different in scope and usage. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reveals the nuances coders must understand to correctly use these modifiers.
HHS and the American Medical Association (AMA) seem to be playing a game of chicken when it comes to ICD-10 implementation. Last year, HHS swerved and the implementation date was moved from October 1...
Our patient Betsy returned to Stitch ‘Em Up Hospital today after suffering a ruptured brain aneurysm. Apparently, the previous treatment to restrict blood flow to the aneurysm was unsuccessful. So Dr...
These days, the healthcare industry is all about the numbers, especially as pay-for-performance becomes more common. Lawrence L. Sanders, Jr., MD, MBA, and Simone R. Gravesande, RN, BSN , review how APR-DRGs work and why all coders should understand them.
E codes are important in a variety of settings. Pamela L. Owens, PhD, Kathy Vermoch, MPH, Leslie Prellwitz, MBA, CCS, CCS-P, and Suzanne Rogers, RHIA, CCS, CCDS, explain the importance of reporting E codes and why every facility should have an internal coding policy that includes E codes.
Q: What advice can you offer for sequencing pulmonary edema and congestive heart failure when both appear to meet the definition of principal diagnosis?
Hospitals continue to report dramatic increases in Recovery Auditor (RA) activity, according to the latest RAC Trac survey results released June 4. The survey found that the number of medical record requests for survey respondents has increased by 53% in comparison to the cumulative total reported in the third quarter of 2012.
The ideal approach to ICD-10-CM/PCS preparation is capitalizing on the synergistic partnership between clinical documentation improvement and coding professionals. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, discusses how organizations can use this dynamic to improve preparations for ICD-10.
Hello Mother, hello Father, Greetings from Camp Murky Water! Camp is very entertaining and they say we’ll have some fun if it stops raining. That better be soon. I just saw a flotilla of ducks take...
CMS released three FAQs about ICD-10 billing, including how to bill encounters that cross the ICD-10 implementation date. That’s October 1, 2014 in case you forgot. And a claim cannot contain both...
Coders use the same CPT ® codes to report outpatient services whether they are coding physician or facility services. Jaci Johnson, CPC,CPC-H,CPMA,CEMC,CPC- I, and Judy Wilson, CPC, CPC-H, CPCO, CPC-P, CPPM, CPCI, CANPC, CMRS, examine the similarities and differences between coding in the two settings.
Q: We get an NCCI edit when billing an intramuscular/subcutaneous injection (CPT® code 96372) during the same encounter as billing an injection, infusion, or hydration. Should we append modifier -59 (distinct procedural service)? Does it matter if an IV line is already in place before intramuscular/subcutaneous administration?
CMS released Special Edition MLN Matters ® Article SE1325 to clarify split billing for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014.
To correctly code for radiation oncology services, coders need to understand the various elements of the treatment. Rebecca Vandiver, CPC, CPC-I, and Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, analyze these complex services from a coding perspective.
Clinical documentation improvement (CDI) initiatives often focus on inpatient documentation to ensure that documentation accurately reflects patient severity. Laura Legg, RHIT, CCS, explains how CDI efforts can also benefit outpatient coding.
In ICD-10-CM, the eyes get their own chapter of codes. No more sharing with the ears, hear that? One of the first things you’ll notice in the chapter on diseases of the eyes is the significant...
Betsy comes in to Stitch ‘Em Up Hospital suffering from a cerebral aneurysm. Dr. Jannettta performs a vessel embolization procedure to treat Betsy. [caption id="attachment_3480" align="alignright"...
In ICD-10-PCS, root operations precisely identify the purpose, intent, or objective of a procedure. Cynthia L. Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-P, highlights the specific—and often subtle—differences in the definitions of ICD-10-PCS root operations.
Q: How will I report the initial insertion of a dual-chamber pacemaker device in ICD-10-PCS? The physician inserted two leads—one into the atrium and one into the ventricle–using a percutaneous approach into the patient’s chest.
CMS has uploaded the latest version of the ICD-10-PCS codes that coders will use for reporting inpatient procedures beginning October 1, 2014. The new files also include the 2014 ICD-10-PCS Official Guidelines for Coding and Reporting .
Coders may be surprised by the expansion and reorganization of codes for diabetes in ICD-10-CM. Pamela Rand, RD, LDN, Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, and Laura Legg, RHIT, CCS, discuss the differences between coding diabetes in ICD-9-CM and ICD-10-CM.
Any ICD-10-CM/PCS to-do list wouldn’t be complete without the task of reviewing and revising query templates. Cheryl Robbins, RHIT, CCS, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Sandra L. Macica, MS, RHIA, CCS, provide tips for updating queries for ICD-10.
Everyone is afraid of something. Some people are terrified of spiders. For others, the mere sight of a snake is enough to send them running in the other direction and screaming at the top of their...
Consider the following: A beneficiary is admitted to a hospital pursuant to a physician order and receives medically necessary care spanning at least two midnights. CMS will consider this appropriate for payment under Medicare Part A, according to the FY 2014 IPPS proposed rule released April 26. Actuaries estimate that this proposal for what constitutes appropriate inpatient care would increase IPPS expenditures by $220 million due to an expected net increase in inpatient encounters. CMS proposes a 2% reduction to offset projected spending increases.
ICD-10 implementation challenges will vary from organization to organization, depending on size, setting, and patient mix. Factor in physician buy-in and budget woes, and implementation seems overwhelming.
In this month's issue, we look at ICD-10 readiness among various stakeholders, reviewing coding for radiation oncology, explain CMS’ new information about Part A to B rebilling, and answer your coding questions.
Most hospitals have been overwhelmed by Recovery Auditor (RA) requests for documentation. So it's no surprise that the RAs themselves seem to be equally as burdened with the task of processing those records.
Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal harmful effects to healthy surrounding cells. To correctly code for radiation oncology services, coders need to understand the various elements of the treatment.
Providers were glad to see CMS' ruling (CMS-1455-R) released March 13 (published in the Federal Register on March 18), which allows full Part B payment for inpatient stays that had been denied as not reasonable and necessary. The ruling had very few details on how the process would work, but on March 22, CMS published Transmittal R1203OTN instructing contractors and providers on the details.
Auto manufacturers rely on them to make decisions about improving passenger restraints in vehicles. Industrial engineers may reference them when advocating for improved design of staircases to prevent falls. Drug companies use them to bolster support for child-resistant packaging.
More than 8% of the population in the United States (i.e., 25.8 million children and adults) has some form of diabetes, according to the American Diabetes Association. In 2007, diabetes was listed as the underlying cause on 71,382 death certificates. It was a contributing factor on an additional 160,022 death certificates.
Auto manufacturers rely on them to make decisions about improving passenger restraints in vehicles. Industrial engineers may reference them when advocating for improved design of staircases to prevent falls. Drug companies use them to bolster support for child-resistant packaging.
Our experts answer questions about hydration, excludes notes in ICD-10-CM, L codes for neurostimulator devices, physician supervision for hyperbaric oxygen therapy, E/M service with wound care, and pass-though drugs.
